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General NPI Number Information
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NPI Number | 1104782432
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Entity Type | Organization
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Legal Business Name | FORTIFY WELLNESS
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 17045 CHATSWORTH ST
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City | GRANADA HILLS
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State | CA
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Zip | 91344-5845
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Country | US
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Telephone | 714-624-7171
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Fax |
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Provider Business Mailing Address
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Address Line | 17045 CHATSWORTH ST
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City | GRANADA HILLS
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State | CA
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Zip | 91344-5845
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Country | US
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Telephone | 714-624-7171
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | HENRY HSU
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Credential | CADC
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Telephone | 714-624-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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